Provider Demographics
NPI:1215002282
Name:MCCARTHY-TAYLOR, KATHLEEN (MSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:MCCARTHY-TAYLOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ELM ST
Mailing Address - Street 2:STE 100
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1903
Mailing Address - Country:US
Mailing Address - Phone:508-753-3960
Mailing Address - Fax:508-753-1785
Practice Address - Street 1:130 ELM ST
Practice Address - Street 2:STE 100
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1903
Practice Address - Country:US
Practice Address - Phone:508-753-3960
Practice Address - Fax:508-753-1875
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1060461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03812Medicare ID - Type UnspecifiedMEDICARE